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Jacob Teitelbaum MD Board certified internist and Medical Director of thePractitioners Alliance Network (PAN)Lead author of groundbreaking research oneffective treatment for Chronic Fatigue Syndromeand FibromyalgiaAuthor of the best-selling books From Fatigued toFantastic! and Pain Free 1-2-3, and The Fatigueand Fibromyalgia SolutionFeatured in many publications, radio andtelevision events, including Good MorningAmerica, CNN, Fox News Channel, the Dr OzShow and Oprah & FriendsKnows CFS/Fibromyalgia as an insider -- hecontracted Chronic Fatigue Syndrome when hewas in medical school and had to drop out for ayear to recover. In the ensuing 35 years, hededicated his career to finding effectivetreatments.

Jacob Teitelbaum MDFeb 2, 2015

It is CRITICAL that you get your 8-9hours sleep night! 100 years ago, the average nightssleep in the USA was 9 hours a night.We are now down to 6 ¾ hours a night People with CFS/FMS get much less

Inadequate Sleep Causes:Fatigue Pain Weight Gain Premature aging Immune Suppression Depression

Common Causes of Poor Quality Sleep1. Hypothalamic sleep center not working(CFS/FMS)2. pain and night time peeing3. day/night cycles switched4. restless leg syndrome5. sleep apnea6. young children7. spouse that snores8. poor Sleep hygiene9. not making time for sleep

Sleep Testing sleep study 1500 (rarely needed)videotape yourselves free (screening)

Start WithThe Basics: Good SleepHygiene

Sleep Hygiene Basics Do not consume caffeine after 4:00 p.m. Do not use the bed for problem solving or doing work Take a hot bath before bed. Add 2 cups of Epsom saltsand some lavender oil to deeply relax Keep the room cool.

Sleep Hygiene If you frequently wake up to urinate during thenight, do not drink a lot of fluids near bedtime. Put the bedroom clock out of arm’s reach andfacing away from you Have a light 1 oz. PROTEIN snack beforebedtime to prevent blood sugar drops.

Sleep HygieneIs sleep disrupted by young children or a bed partnerwith snoring (e.g.- sleep apnea) or restless legs. If soRx with:wax earplugsdelta wave sleep CD or white noise makerseparate bedroomstreat the spouse(as below. Sometimes"Breath Right” nose strips help).

Got Nasal Congestion?If you mouth breath, your sleep may notbe restorative Breath Right Nose Strips Nozovent Treat the Candida (sinusitis sprays and6 weeks of diflucan) . If persists, check for UARS

GOOD QUALITY SLEEP12

Routine Sleep TreatmentsNatural

Revitalizing Sleep Formulavalerian, passion flower, lemon Balm, hops, theanine and wild lettuce

Herbal Sleep Aids Wild Lettuce—traditionally, wild lettucehas been found to be wonderful foranxiety and insomnia, as well as forheadaches, muscles, and joint pain.Wild lettuce also helps to calmrestlessness and reduce anxiety.

Herbal Sleep Aids Lemon Balm (Melissa) . Very helpfulfor sleep when combined withValerian. Also viral suppressant

Herbal Sleep Aids Hops—this is a member of the hemp family, andthe female flowers are used in beer making. It alsostimulates some hormonal activity; can suppressbreast, colon, and ovarian cancer in test tubestudies. It also is associated with antibiotic andanti-fungal activity. It has a long history of beingused for anxiety and insomnia. A study using 120mg of hops combined with 500 mg of valerianshowed an improvement in insomnia witheffectiveness similar to Valium familymedications. It is considered to be very safe.

Herbal Sleep Aids Valerian—this is commonly used as a remedy for insomnia.One placebo-controlled study showed that people takingvalerian (400 mg of extract each night for 2 weeks) fellasleep quicker and had better sleep quality without next-daysedation. Another placebo-controlled study using 450 and900 mg doses for just 1 night also showed improved sleep,but there was some hangover with the higher dose. Anumber of other studies also show benefit, including animprovement in deep sleep. The benefits were mostpronounced when people used it for extended periods asopposed to simply taking it for 1 night. Another study showedit to be as effective as a Valium family medication(Oxazepam ). A review of multiple studies found that“Valerian is a safe herbal choice for the treatment of mildinsomnia and has good tolerance Most studies suggestthat it is more effective when used continuously rather thanas an acute sleep aid.”

Herbal Sleep Aids Passionflower (Passiflora)—this excellent herb isused throughout South America as a calmingagent and is even present in sodas. In fact, whenone is anxious, it is not uncommon for their friendsto tell them “why don’t you go get a passion flowerdrink.” In addition to being used in the treatment ofmuscle spasms, herbalists have also used it totreat colic, dysentery, diarrhea, anxiety, andmenstrual pain. A number of studies support itshaving a calming effect. Early data also suggeststhat it may increase men’s libidos.

Herbal Sleep Aids Theanine—this comes from green teaand has been shown to improve deepsleep and to also help people maintaincalm alertness during the day. Greentea also is helpful as an immunestimulant and has many other benefits.

Revitalizing Sleep Formula Valerian 200mg, Passion Flower 90mg, L-Theanine50mg, Hops 30mg, Lemon Balm 20 mg, and WildLettuce 28mg. Take 2-4 capsules 1 hour beforebedtime. Can also be used during the day foranxiety.Use 1-4 caps at night, and it can also be used duringthe day for anxiety and muscle pain. It would bedifficult to overdose.If Valerian energizes the patient (occurs in 5-10% ofpeople) use other components.

5 HTP (5 Hydroxytryptophan)200 to 400mg at night. Naturallystimulates Serotonin. Don’t take over200mg a day on serotonin raising drugs,e.g.- ANTIDEPRESSANTS Can help with pain and weight loss at300mg a day for at least 3 months. May takes 6-12 weeks to see full effects.

Lavender –Calm AidThe smell of lavenderhelps sleep Flowers or oil foraromatherapy Lavender oil caps bymouth are very helpfulfor both sleep andcalming. 1 at bedtime and/or 2 xday for calming

Melatonin½ mg - 1 at bedtime Don't use a higher dose, unless you find itto be more effective (.5mg is usually aseffective as 5mg). For night time acid reflux, 5 mg dose maybe better

Magnesium at bedtime helpssleep.Avoid the runs with JigsawMagnesium SR

Mind Wide Awake at Bedtime?Reversed day-night cycles Often adrenal problem from loss ofproper circadian rhythm, so cortisol istoo low during the day and too high atnight—so your best function is 10 pm to2 am ! What to do?

Sleep TonightWith Sleep Tonight! A mix of Ashwagandha PhosphatidylSerine Magnolia Bark

Doxylamine (Unisom For Sleep)-OTC)25 mg at night (an antihistamine).May also help nerve painCan also try Benadryl or DramamineSide effects: sedation, dry mouth,increased dementia risk in those over 60

Prescription Sleep Aids Cancombine with natural products. Adjustdose as needed to get 7-9 hours of solidsleep without waking or hangover. Mixinglow doses of several treatments is morelikely to help sleep without a hangover than ahigh dose of 1 medication. Optimizehormones

Prescription Sleep AidsFor next day sedation problems, considertaking the medications (except theAmbien) a few hours before bedtime (nodriving on them!)Antidepressants (e.g., Prozac/Paxil) canimprove sleep after 6 weeks.

Prescription Sleep AidsThe Best Options:*Ambien (Rx, zolpidem) - 5 mg- ½ to 2 at bedtime.If wakesduring the night, can take an extra ½ to 1 tablet crushedand placed under your tongue or switch to Ambien CR6.25 or 12.5 mg. Maximal night dose is best 12.5 mg orless* Desyrel (Rx, trazodone) - 50 mg - ½ to 1 at bedtime. Alsogood for anxiety.* Flexeril (Rx, cyclobenzaprine) - 5 mg- ½ to 1 at bedtime.Muscle relaxant - can cause dry mouth.

The Best Options- Continued .* Neurontin (Rx; gabapentin) 100 mg 1-6caps at bedtime. Also helps pain andrestless legs syndrome.* Doxepin (Rx, Sinequan) – 5-10mg, 1-3capsules at bedtime or Doxepin liquid10mg/cc. If a lower dose is needed youcan start with 1-3 drops at night.* Zanaflex- 4 mg ½ -2 at bedtime for sleep(more for pain).Stop if it causesnightmares.

Sleep ApneaClinically significant ( 15/hr) in 3-17% ofadults. Likely being missed in 99% of casesbecause of lack of M.D. awareness(Annals of Int Med).

Sleep ApneaCan be: Obstructive (OSA)-most common. Usuallyfrom being overweight. Common with necksize 16&1/2". Common cause of autoaccidents and HTN. Central-Seen in CMI (Chiari malformation)

Sleep Apnea Doyou snore? If yes: Are you more than 20lbs overweight? Do you have periods that you stopbreathing (ask your bed partner)? Do you have high blood pressure? Testing (on Rx)-sleep study . 1500 (rarelyneeded) videotape yourselves-free (screening)

Treatment of Sleep Apnea Weightloss Surgery or appliances Tennis ball in small of back CPAP-Poorly tolerated . 25% use it.

Restless leg syndrome (PLMD)Very Common. Natural Rx: Treat low iron. Get the ferritin level over 60! B12, folate, 5-HTP, kava, wild lettuce Thyroid bedtime protein snack for nocturnalhypoglycemia

Night sweats can disrupt sleepMain causes: Low Estrogen in women and lowtestosterone in men (use treatment atbedtime) infections (esp. yeast) acid reflux/aspiration- raise HOB nocturnal hypoglycemia-Rx with 2&1/2 mgcortef or protein snack HS

Daytime sleepiness (vs fatigue but can'tsleep). Think: Sleep Apnea Narcolepsy Sedation from meds

Poor sleep in CFS andFibromyalgia is usuallysecondary to thehypothalamic sleepdysfunction.

In CFS and FibromyalgiaTo restore normal hypothalamicfunction, the person needs to get8-9hours of deep sleep a night for atleast 6 months! Need to stay onsome sleep support long term.

Summary Begin with sleep hygiene and making timefor at least 8 hours of sleep a night.Add the herbals found in the “RevitalizingSleep Formula” followed by magnesium,Calm Aid (lavender), 5 HTP and Melatoninat bedtime for excellent sleep supportIf mind is wide awake at bedtime, addSleep Tonight mixOptimal sleep will help you stay young,trim, and healthy

GOT FATIGUE?There are 5 steps neededto optimize energyThese 5 steps are 43

Remember “SHINE”SHINE44

Making it simple!The free “Energy Analysis Program”program atwww.EndFatigue.comVia simple quizzes, and even review oflabs if available), assesses the cause(s) ofyour low energy, and tailors a detailedrecommendation list for your case, so youcan optimize vitality!45

ADDRESSING PAIN46

PainUntil you treat the disordered sleep, painwill simply not resolve Pain both causes and is caused by poorsleep

CURAMIN—A Pain Relief MIRACLE! Bioavailable curcumin, Boswellia ( 15% AKBA, 5%beta boswellic acid), DLPA, nattokinase Best curcumin absorption: micronize and mix back with tumericessential oils; high bioavailability in human absorption tests ANDvery safe Beta boswellic acid CAUSES inflammation; reducing the amountfound in a boswellia extract to 5% doubles its effectiveness DLPA – amino acid L-phenylalanine naturally boosts mood-supporting and painrelieving brain compounds (serotonin and dopamine) D-phenylalanine naturally blocks the breakdown of the brain’snatural pain killing compounds (endorphins) Nattokinase Enzyme from fermented natto Increases circulation, breaks up clots

What this Means? Curamin KICKS PAIN’S BUTT!!!

A Natural Pain FormulaWillow Bark Boswellia Cherry

Rub Pain Away!

Making an Appointment with Dr. TI do phone and in person consultationsfor people with CFS/FMS worldwide Contact Sarah atappointments@EndFatigue.comor call 410-573-5389 and leave amessage Consultations include 3-4 hours of my oneon-one time, and are very thorough!52

Resources www.EndFatigue.com Free e-mail newsletter—give your e-mailaddress to sign up today Free Energy Analysis Program Cures A-Z app Useful articles Monthly webinars- 1st Monday each month And much, much, much more!53

Special Q&A Webinars For “Get Well NOW Club” Memberswho use our auto-ship program 2nd Monday of each month at 4pm EST Get your questions answered byDr. T54